Understanding Your Baby – 4 Months

Understanding Your Baby 4 Months

Glacier Medical Associates

1111 Baker Ave Whitefish, MT 59937 862‐2515

Teaching Your Baby

Continue to help your baby learn by spending time doing the following:

 Help your baby learn to sit up by sitting on the floor with her put toys just out of reach and watch your baby learn to use her body as she reaches for the toy  Show your baby faces in the mirror demonstrating different feelings  Incorporate daily tummy time into his play time  Play hide‐and‐seek and peek‐a‐boo games to teach your baby that you go away, and then you come back.

Development and Normal Activity

While certain behaviors and physical milestones tend to occur at certain ages, a wide spectrum of growth and behavior for each age is normal. Contact your doctor if you have concerns about your child’s development.

By this age, most babies are better able to control the muscles that support their head, arms, and legs. When a 4 month old is pulled into a sitting position, the head is brought up without lagging behind. In the sitting position brought up without lagging behind. In the sitting position the head tilts a little forward, but is held steady without bobbing. The arms are strong enough that babies can raise their chest and hold their head high if they are placed on their stomach. Babies also likely will roll from side to side. When on their back, they may be able to roll to their side.

As babies learn to reach their mouth with their hands, they may suck their fingers or other objects. A four month old infant will be able to grasp objects. A four month old infant will be able to grasp objects of moderate size like a rattle. You should be careful of small things that can be inhaled or swallowed. Remember that anything in a baby’s hand will end up in the mouth. Babies at this stage can see as well as their parents and are fascinated with their mirror image!

As the weeks go by, babies’ individual personalities become more apparent. They may smile as soon as they see a familiar person. They may also coo, gurgle, chuckle, squeal, and have a real “belly laugh.” They may also show their unhappiness when leaving familiar people by change of expression, fussing, or crying. It is normal for babies to cry. At this age you can’t spoil a baby. Meeting your baby’s needs quickly is still a good idea.

Feeding

Your baby should still be taking breast milk or infant formula. Most babies now suck for 20 to 40 minutes per breast or take about 6 ounces of formula every 4 to 5 hours. Check formula temperature carefully befog feeding, it should be warm or cool to touch. Until 6 months of age, breast milk or formula still gives babies the full nutrition they need. However, babies can be introduced to solid foods gradually over the next several months.

Some babies may be ready to start cereal, although it is not necessary to start cereal until the age of 6 months. A baby is ready for cereal when:

 He is able to hold his head up enough to eat from a spoon.  He can sit up with support.  He can show you when he is full (turns his head, won’t open mouth).

Cereal should not be given from a bottle. When you start cereal, start with rice cereal (it causes the fewest allergies) mixed with breast milk or formula. You may want to tart with a thin mix of cereal and then thicken it gradually. Start by offering 1 to 2 tablespoons of baby cereal and gradually increase to 2 servings a day. After a few weeks you may add barley or oat cereal for variety. Pureed fruits and vegetable should be avoided until 6 months of age to avoid food allergies.

Never leave the baby in bed with a bottle because it can lead to tooth decay. Don’t give your baby a bottle just to quiet him when he really isn’t hungry. Babies who spend too much time with a bottle in their mouth have more ear infections. They also start to use the bottle as a security object, which makes weaning more difficult.

Sleep

Your 4 month old may get as much as 10 hours of sleep at night, but may still need night feeding. Your infant should be starting to be able to fall asleep by himself and should be able to comfort himself in the middle of the nigh without being held. You can help this by establishing

2 a bedtime routine, and putting your baby to bed while she is awake so she learns to fall asleep without food or being held. Your baby will also nap 4 to 6 hours during the daytime.

Safety Tips

 Use only unbreakable toys without sharp edges or small parts that can’t come loose. The parts on toys for children younger than tree should not be smaller than 1 ¼ inches across or 2 ¼ inches long. Any part smaller than this could cause your child to choke.  Remove hanging mobiles or toys before the baby can reach them.  Keep cords, ropes, or strings away from your baby, especially near the crib. Ropes and strings around the baby’s neck can choke him. Keep plastic bags and balloons out of reach.  Never eat, drink, or carry anything hot near the baby while you are holding the baby.  Turn down your water heater to 120°F (50°C).  Check your smoke detectors to make sure they work.  Quit smoking. If you smoke, don’t smoke in the house or near the baby.  Wear safety belt. Use an approved infant car seat correctly in the back seat. Never leave your baby alone in a car.  Never leave the baby alone on a high place.  Keep crib and playpen sides up.  Do not put your baby in a walker.  Never leave your child alone, except in a crib on his back.  Keep the number for poison control handy: 1‐800‐860‐0620

Immunizations and Next Doctor’s Visit

At today’s visit, your baby should have:

 DTap 2ND dose Diptheria, tetanus and acellular pertussis  Hib 2nd dose Haemophilus influenza type B  IPV 2nd dose Inactivated poliovirus  PCV 2nd dose Pneumococcal pneumonia

Your baby may fun a fever and be irritable for about 1 day after getting shots. Your baby may also have some soreness, redness, and swelling where the shots were given. Acetaminophen (Tylenol) may help to prevent the fever and irritability. Be certain to use infant strength drops (80mg/0.8 mL). The appropriate dose for your baby is:

 Acetaminophen: 80‐100 mg (0.8‐1 mL) of infant drops every 4 to 6 hours.

3 For swelling or soreness put a wet, warm washcloth on the area of the shots as often and as long as needed for comfort.

Your baby’s next routine visit should be at the age of 6 months. At this time your child will get the next set of immunizations. Please bring the shot record to each visit.

Call Your Child’s Physician If:

 Your child has a rash or any reaction to the immunizations other than fever and mild irritability.  Your child has a fever that lasts more than 36 hours.

You can reach a doctor 24 hours a day by calling: 862‐2515

What to Expect

In the next few weeks most babies will be able to turn from their back to their stomach. They also may begin to make motions as if they are crawling. Their heads will become more stable when they are propped in a sitting position. They also will begin to make several new babbling sounds. Your baby will continue to explore the world around him with his eyes, fingers, hands and mouth. Everything will seem to go into the mouth blankets, toys, fingers, and toes, accompanied by much drooling.

Passive Smoke

Nonsmoking children who live in homes with smokers are involuntarily exposed to cigarette smoke. Children who live in a house where someone smokes have an increased rat of all respiratory infections. Their symptoms are also more severe and last longer than those of children who live in a smoke free home. The impact of passive smoke is greatest during the first 5 years of life when children spend most of their time with their parents.

Many conditions are made worse by passive smoking including pneumonia, bronchitis, croup, laryngitis, bronchilolitis, asthma, influenza, ear infections, upper respiratory infections, sinusitis, and crib death (SIDS).

There are things you can do to prevent these problems and protect your child from passive smoking.

 Give up active smoking. You can stop smoking and it may be easier help. Ask your doctor for advice or contact the American Lung Association (1‐800‐448‐5864). If you want your child not to smoke, set a good example.

4  Never smoke inside your home. Restrict your smoking to times away from home or smoke only in your garage or on the porch. Change clothes when you come inside.  Never smoke while holding your child. In addition, never smoke in your car with the child.  Avoid leaving your child with a caretaker who smokes.